Compliance Auditor-Senior (Medical Coding & Billing)

Job Description

Under general supervision responsible for helping to execute the UT Health San Antonio's (UTHSA) Compliance Work Plan. Responsible for facilitating UTHSA's compliance with federal and state laws and regulations. Conducts monitoring and auditing activities, documenting findings and corrective action plans, investigating issues of noncompliance, and providing educational compliance related training to workforce members.

Responsibilities

• Performs Medical Billing Audits consistent with regulatory and compliance requirements of federal and state laws and regulations.
• Performs a variety of duties to ensure that regulatory requirements and operational policies and procedures are effectively implemented, monitored, and validated through auditing.
• Identifies and defines audit scope and criteria, reviews and analyzes evidence and documents audit findings, including making recommendations for improvement and correction where identified.
• Identifies and tracks progress on corrective actions, and drafts findings reports.
• Assists in the general development of the annual Compliance Work Plan, training, and policies and procedures.
• Serves as a resource and compliance subject expert to highlight key areas of compliance risk and collaborates with internal and external stakeholders to put forth recommendations for process/ procedural enhancements.
• Assists with the compliance awareness, education, and training initiatives of the organization.
• Assists in conducting investigations involving instances of non-compliance. Assists in performing an annual research compliance risk assessment and development of audit plans.
• Performs all other duties as assigned.

Qualifications

• Ability to review, analyze, and interpret regulatory requirements in a concise manner.
• Demonstrated analytical skills to assess and synthesize information; identifying key factors, trends and issues; identify and summarize possible risks to the institution.
• Project management and organizational skills needed in order to meet strict deadlines.
• Healthcare privacy and compliance knowledge and experience.
• Experience conducting privacy and compliance related investigations.
• Ability to travel to regional facility locations, and collaborate across and within different levels of the organization.
• Excellent customer service skills and strong willingness to take initiative.
• Strong verbal, written and interpersonal communication skills.
• Well-versed in UTHSA's policies and procedures.

EDUCATION:

• Bachelor's degree in Finance, Business Administration, Healthcare Administration, Medical Records, or related field, or equivalent experience is required.
• Master's degree is preferred.

EXPERIENCE:

• Five (5) years prior healthcare compliance related experience, or related experience is required.
• Three (3) years of prior experience will be accepted with a Master's degree.

LICENSE AND CERTIFICATION:

• Professional coding certification from an accredited agency is required.
• Professional Auditor certification to be obtained within 1 year of employment.
• Certified in Healthcare Compliance (CHC) is preferred.